Effective Jan. 1, 2019, the BMC HealthNet employee benefit plan will be administered by Health Plans, Inc. (HPI), a Harvard Pilgrim company. Please be aware of the following regarding this change.
BMC HealthNet employees are aware of the change and have been issued new ID cards (see sample below), which display the BMC Select and HMO plan names and Health Plans logo prominently.
Checking benefits & eligibility
Visit www.healthplansinc.com/providers to check benefits and eligibility. Simply click on “Check Eligibility” and follow the onscreen prompts.
PCPs and referrals
BMC HealthNet members on HPI’s Select and HMO plans must have a PCP to coordinate care. In addition, referrals are necessary for members of Select and HMO plans for certain services. Please keep in mind that if the PCP is making the referral within his or her established referral circle with Harvard Pilgrim (usually among specialists in the PCP’s care unit), a referral transaction is not required. However, if a PCP is referring the HMO member outside of his or her referral affiliation, a referral transaction is necessary.
In addition, the following services do not require a referral: family planning services; outpatient maternity services; gynecological services; acupuncture; chiropractic care; routine vision exams; emergency services; and urgent care services with participating providers. Services requiring authorization also don’t require a referral.
To submit a referral in 2019, visit the Referral Portal. If you haven’t already registered to submit referrals to HPI, you’ll need to register online by completing the Referral Portal Access Form.
Or, if you prefer to submit referrals on paper, you can find these in the Access Forms section of the HPI website.